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American Red Cross ACLS Final Actual
Exam – 50 Most Tested Questions with
Answers & Rationales (2025/2026 Edition)
| Instant PDF Download
Question 1
A 68-year-old male presents with chest pain radiating to his left
arm. He is diaphoretic and nauseous. His blood pressure is
90/60 mmHg, heart rate 120 bpm, and oxygen saturation 88%
on room air. What is your FIRST action?
A) Administer sublingual nitroglycerin
B) Start a peripheral IV and give morphine
C) Apply oxygen and establish cardiac monitoring
D) Administer aspirin 324 mg chewable
Correct Answer: C
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Rationale: The ABCDE approach prioritizes airway, breathing,
and circulation. This patient is hypoxic (SpO2 88%), so
supplemental oxygen should be applied immediately. Cardiac
monitoring should follow rapidly. Aspirin is important but comes
after ensuring adequate oxygenation. Nitroglycerin is
contraindicated with hypotension (SBP <90 mmHg).
Question 2
What is the recommended compression depth for adult CPR?
A) At least 1.5 inches (4 cm)
B) At least 2 inches (5 cm) but not exceeding 2.4 inches (6 cm)
C) Exactly 2.5 inches (6.4 cm)
D) At least 3 inches (7.5 cm)
Correct Answer: B
Rationale: The 2020 AHA/Red Cross guidelines recommend a
compression depth of at least 2 inches (5 cm) for an adult, with
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an upper limit of 2.4 inches (6 cm) to avoid injury. Excessive
depth increases risk of rib fractures and internal organ damage
without improving outcomes.
Question 3
A patient in cardiac arrest has an advanced airway in place.
What compression-to-ventilation ratio should be used?
A) 30:2 continuously
B) 15:2 continuously
C) Continuous compressions at 100-120/min with 1 breath every
6 seconds
D) Continuous compressions at 80/min with 2 breaths every 30
compressions
Correct Answer: C
Rationale: Once an advanced airway (endotracheal tube or
supraglottic airway) is placed, rescuers should deliver continuous
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chest compressions at 100-120 per minute without pausing for
ventilations. Provide 1 breath every 6 seconds (10 breaths per
minute) asynchronously.
Question 4
Which medication is considered the FIRST antiarrhythmic agent
for shock-refractory ventricular fibrillation/pulseless ventricular
tachycardia?
A) Lidocaine
B) Magnesium sulfate
C) Amiodarone
D) Epinephrine
Correct Answer: C
Rationale: Amiodarone (300 mg IV/IO push, followed by 150
mg if needed) is the first-line antiarrhythmic for VF/pVT
refractory to defibrillation. Epinephrine is given for vasopressor
American Red Cross ACLS Final Actual
Exam – 50 Most Tested Questions with
Answers & Rationales (2025/2026 Edition)
| Instant PDF Download
Question 1
A 68-year-old male presents with chest pain radiating to his left
arm. He is diaphoretic and nauseous. His blood pressure is
90/60 mmHg, heart rate 120 bpm, and oxygen saturation 88%
on room air. What is your FIRST action?
A) Administer sublingual nitroglycerin
B) Start a peripheral IV and give morphine
C) Apply oxygen and establish cardiac monitoring
D) Administer aspirin 324 mg chewable
Correct Answer: C
,Page 2 of 196
Rationale: The ABCDE approach prioritizes airway, breathing,
and circulation. This patient is hypoxic (SpO2 88%), so
supplemental oxygen should be applied immediately. Cardiac
monitoring should follow rapidly. Aspirin is important but comes
after ensuring adequate oxygenation. Nitroglycerin is
contraindicated with hypotension (SBP <90 mmHg).
Question 2
What is the recommended compression depth for adult CPR?
A) At least 1.5 inches (4 cm)
B) At least 2 inches (5 cm) but not exceeding 2.4 inches (6 cm)
C) Exactly 2.5 inches (6.4 cm)
D) At least 3 inches (7.5 cm)
Correct Answer: B
Rationale: The 2020 AHA/Red Cross guidelines recommend a
compression depth of at least 2 inches (5 cm) for an adult, with
,Page 3 of 196
an upper limit of 2.4 inches (6 cm) to avoid injury. Excessive
depth increases risk of rib fractures and internal organ damage
without improving outcomes.
Question 3
A patient in cardiac arrest has an advanced airway in place.
What compression-to-ventilation ratio should be used?
A) 30:2 continuously
B) 15:2 continuously
C) Continuous compressions at 100-120/min with 1 breath every
6 seconds
D) Continuous compressions at 80/min with 2 breaths every 30
compressions
Correct Answer: C
Rationale: Once an advanced airway (endotracheal tube or
supraglottic airway) is placed, rescuers should deliver continuous
, Page 4 of 196
chest compressions at 100-120 per minute without pausing for
ventilations. Provide 1 breath every 6 seconds (10 breaths per
minute) asynchronously.
Question 4
Which medication is considered the FIRST antiarrhythmic agent
for shock-refractory ventricular fibrillation/pulseless ventricular
tachycardia?
A) Lidocaine
B) Magnesium sulfate
C) Amiodarone
D) Epinephrine
Correct Answer: C
Rationale: Amiodarone (300 mg IV/IO push, followed by 150
mg if needed) is the first-line antiarrhythmic for VF/pVT
refractory to defibrillation. Epinephrine is given for vasopressor
